Long-Term Outcome of Aortic Root Remodeling for Patients With and Without Acute Aortic Dissection

Kunihara, Takashi; Neumann, Niklas; Kriechbaum, Steffen; Nomura, Ryota; Schäfers, Hans‐Joachim

doi:10.1253/circj.cj-17-0182

Cited by 8 publications

(2 citation statements)

References 32 publications

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“…1 Kaplan-Meier analysis of overall survival following root remodeling. Dotted lines indicate 95% confidence interval dissection, we have seen the best stability remodeling [27]. One may argue that reduction of annular size improves coaptation height [28] and thus compensates inaccuracies of cusp repair.…”

Section: Discussionmentioning

confidence: 74%

Aortic root remodeling in bicuspid and tricuspid aortic valves—long-term results

Miyahara

Karliova

Giebels

et al. 2019

Indian J Thorac Cardiovasc Surg

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Background Root remodeling is one form of valve-preserving root replacement to treat patients with aortic regurgitation (AR) and root aneurysm. We have consistently used it for patients with and without connective tissue disease and different aortic valve morphologies. The objective of this retrospective study was to review 23 years of experience with root remodeling. Methods and patients Between 10/95 and 9/2018, 1004 of 1038 root remodeling procedures were performed in patients with tricuspid (n = 589) or bicuspid (n = 414) anatomy of the aortic valve in our institution. Aortic aneurysm was present in 932 cases, 73 procedures were performed for acute aortic dissection type A. The severity of aortic regurgitation ranged from grade I to grade IV (mean 2.5 ± 0.8). Results All patients underwent root remodeling, concomitant operations were performed in 433, and cusp repair in 883 instances. Hospital mortality was 2%. Overall freedom from reoperation was 92% at 10 years and 89% at 15 years. It was 94% for tricuspid valves at 10 and 15 years, and 88% for bicuspid aortic valves at 10 years and 80% at 15 years (p = 0.003). Conclusion In conclusion, root remodeling is a viable option in valve-preserving root replacement. If combined with careful assessment and, if necessary, correction of aortic valve form reproducible restoration of aortic valve function can be achieved.

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Section: Discussionmentioning

confidence: 74%

Aortic root remodeling in bicuspid and tricuspid aortic valves—long-term results

Miyahara

Karliova

Giebels

et al. 2019

Indian J Thorac Cardiovasc Surg

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“…Root remodeling has become our preferred approach to all individuals with root enlargement and a non-calcified aortic valve irrespective of the degree of preoperative AR. Also, in acute dissection with pre-existent root dilatation, we have seen excellent valve stability with this operation ( 18 ).…”

Section: Commentsmentioning

confidence: 80%

Aortic root remodeling

Giebels¹,

Ehrlich²,

Schäfers³

2023

Ann Cardiothorac Surg

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Aortic root remodeling was originally designed in the late 1980s to treat patients with tricuspid aortic valves (TAVs), aortic regurgitation (AR), and root aneurysm to normalize root dimensions. The late results showed a relevant proportion of patients who required reoperation for recurrent AR. Later observations revealed that cusp prolapse is frequently present after correction of root dilatation. We showed that such prolapse could be detected by measuring effective height (eH) and corrected by concomitant cusp repair. In the past 13 years, we have added a suture annuloplasty to improve aortic valve function further. The operation starts with ascertaining adequate cusp size by measuring geometric cusp height. The dilated aortic wall is resected, and a Dacron graft is tailored to create three tongues. These tongues are sutured to the cusp insertion lines. Starting the suture in the nadir allows for easy extension of tongue length to avoid commissural height restriction. A suture annuloplasty is added at nadir level and tied around a Hegar dilator to normalize annular diameter. The valve is assessed visually and by measuring eH. Cusp prolapse (eH <9 mm) is frequent and corrected by free margin plication until all free margins are at equal level and eH is 9 mm. We have employed root remodeling in more than 710 instances of root aneurysm and TAVs. Mean myocardial ischemic time has been 65±13 minutes for isolated remodeling, operative mortality has been 1.5% for elective procedures. With suture annuloplasty, 10-year freedom from reoperation is 95%, even without suture annuloplasty 20-year freedom from reoperation is 85%. In our experience, root remodeling has been a valid form of valve-preserving surgery with low morbidity and mortality and excellent long-term results.

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Die thorakale Aorta

Stanger

2020

Kompendium Der Modernen Herzchirurgie Beim Erwachsenen

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Long-Term Outcome of Aortic Root Remodeling for Patients With and Without Acute Aortic Dissection

Abstract: Long-term stability of remodeling was comparable between patients with and without AADA.

Cited by 8 publications

References 32 publications

Aortic root remodeling in bicuspid and tricuspid aortic valves—long-term results

Aortic root remodeling in bicuspid and tricuspid aortic valves—long-term results

Aortic root remodeling

Die thorakale Aorta

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